Paravertebral Blocks for Postoperative Pain in Laparoscopic Cholecystectomy: A Systematic Review and Meta-analysis of Randomised Controlled Trials

Background: Although laparoscopic cholecystectomy (LC) is a minimally invasive surgery, it does not eliminate postoperative pain completely. Paravertebral block (PVB) is a regional anaesthesia technique that has gained attention as an effective pain reduction technique. Despite its proven efficacy in several surgeries, the role of PVB in LC pain management remains undecided. Aim: This systematic review and meta-analysis aim to evaluate the effectiveness of PVB in reducing postoperative pain and improving patient outcomes following LC. Methods: A systematic review and meta-analysis were conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and registered in Prospective Register of Systematic Reviews (CRD4202588578). A comprehensive search of PubMed, Google Scholar and Web of Science was performed using predefined keywords. Inclusion criteria were randomised controlled trials (RCTs) published in English between 2010 and 2024, involving patients undergoing LC with PVB as part of their anaesthesia regimen. Studies not meeting RCT criteria, non-human studies and articles without full-text access were excluded. Data extraction and risk of bias assessment were performed independently by two authors. Statistical analysis, including standardised mean difference (SMD) and risk ratio (RR), was conducted using a random-effects model. Results: Eight RCTs, involving 573 participants, met the inclusion criteria. PVB significantly reduced post-operative pain scores, analgesic consumption and the incidence of post-operative nausea and vomiting (PONV) compared to control groups. The pooled analysis showed a lower need for additional analgesia (RR = 0.417, P = 0.002) and a reduced risk of PONV (RR = 0.413, P = 0.011). While PVB improved early ambulation and patient satisfaction, it had no significant impact on operative time (SMD = 0.161, P = 0.294) or length of hospital stay. Shoulder pain outcomes were inconsistent throughout studies. Conclusion: PVB is an effective analgesic strategy for LC, offering superior pain control, reduced analgesic needs and enhanced recovery experience. While it does not have an impact on operative duration or hospital stay, its aid in pain reduction and patient satisfaction make it a promising choice for postoperative pain management. Further research is looked-for to clarify its impact on shoulder pain and optimise its clinical application.